New Vet Client Information

mobile vet client info puppy Thank you for giving us the opportunity to care for an important member of your family. Please help us better meet your needs by taking a few minutes to completely fill out this information sheet. In order to better care for your pets, we ask that you update us as your information changes. We look forward to providing for your veterinary needs.

Please Complete and submit online using the web form below.

*We respect your privacy. All client information is confidential, including Email addresses.

Online Vet Client Info Form

Owner Name*
First Last
Street Address*
Street Address Address Line 2 City State ZIP Code
Subdivision (if applicable)
Gate Code (if applicable)
Apartment/Unit Number (if Applicable)
Mailing Address
- My mailing address is the same as my street address.
- I have a different mailing address.
Physical address is required in order to provide accurate estimates and determine whether location is within our service area
Mailing Address Details
Street Address Address Line 2 City State ZIP Code
Home Phone/Cell Phone*
Work Phone
Email
Spouse Name (if applicable)
Spouse Phone
Pet Info
Pet's Name (1)
Species*
- Dog
- Cat
- Other (Goat, Rabbit, Guinea Pig, and others
Age/Date of Birth
Approximate is OK.
Sex
Color and Breed
Approximate Weight*
Temperament*
- Calm/Friendly
- Shy but freindly
- Anxious
- Indifferent
- Fearful
- Strangers need to be cautious
Please describe the current condition of pet. Please
Please list any medications the pet is taking at present, including any Flea/Tick Preventative or Heartworm Prevention.
Current Medications
Please list any medications the pet is taking at present, including any Flea/Tick Preventative or Heartworm Prevention.
Diet/Food
Please list food the pet is currently eating. Please include Brand if possible.
Pet Name (2)
Species
- Dog
- Cat
- Other (Goat, Rabbit, Guinea Pig, and others
Date of Birth
Approximate is OK.
Sex
Color and Breed
Approximate Weight
Temperament
- Calm/Friendly
- Shy but freindly
- Anxious
- Indifferent
- Fearful
- Strangers need to be cautious
Medications
Please list any medications the pet is taking at present, including any Fleat/Tick Preventative or Heartworm Prevention.
Diet/Food
Please list food the pet is currently eating. Please include Brand if possible.
What kind of treats and/or people food do you give?
Please list treats, or people food, the pet is commonly eating. Please include Brand if possible.
Name of Previous/Current Veterinarian*
Name of Current/Previous Veterinarian or Enter "None"
Do you authorize us to obtain copies of your pet(s) records?*
- Yes
- No
- I will provide records for this pet at least 48 hours prior to the appointment by email or text.
Your pets records are essential to ensure they receive proper care.
How Did You Learn Of Our Service?
- Internet/Website
- Facebook/Nextdoor
- Advertisement
- Friend or Family
- Sign/Vans
- Word of Mouth
Who can we thank for the referral?
Comments. Please discuss current condition of pet and any major illness diagnoses.
1. I understand that payment is expected when services are rendered, unless other arrangements are made prior to when services are provided.
2. I understand that appointment changes or cancelations will be requested with at least 48 hours notice. Appointment cancelations with less than 48 hours notice may be subject to a cancelation fee equal to the travel fee.

3. I understand a service fee of $50.00 will be assessed if an insufficient fund check is received.

4. I understand that Mobile Vet to Pet requires patients to be vaccinated against Rabies Virus as required by Florida Law, unless vaccination would endanger the animal’s health as determined by the Veterinarian examining the pet.
5. I understand that an adult owner, or a representative with written permission, must be present for all appointments.
 6. I agree to receive text messages from Mobile Vet to Pet with the understanding I may opt out at any time.

7. I understand it is my right to receive a written prescription for medication that can be filled at the pharmacy of my choice or by my veterinarian, as provided in s. 474.224, Florida Statutes.

By Signing below, I acknowledge and understand the provisions above.
I understand and agree to each acknowledgement above. Signature (Type Name Below)*
Date
I Am Ready To Send This Form
- Yes
Please click Yes and then click the Submit button. This form will be sent to our office electronically and you will automatically receive a copy for your records. You will also have the option of receiving our free pet newsletter.

Contact Us Today

Mobile Vet to Pet, LLC
Dr. Joell Sheahan & Dr. Marie Gravatt
Clermont, FL 34715
Phone: 352-978-0494
Email: Office@myVet2Pet.net

Convenient Appointments

We schedule appointments Monday through Friday 9am to 5pm. Flexible hours also available. Experience loving vet care in the comfort of your home!

After Hours Emergencies

Emergencies are referred to the Veterinary Emergency Center, 16369 West Colonial Drive, Oakland, FL 34787. Phone: 407-644-4449 x5

Online Vet Client Info Form

Pet Info

Contact Us Today

Convenient Appointments

After Hours Emergencies